Research verifies overweight status among children under the age of 3

One-third of the 358 infants assessed in one Brazilian city presented as overweight, according to a survey conducted at the University of São Paulo School of Nursing.

By Karina Toledo and Fernando Cunha

Agência FAPESP – A nutritional assessment of children under the age of 3 conducted in the city of Itupeva, in inland São Paulo, found that nearly one-third were overweight, but only 20% of the mothers of overweight children were aware of the problem. The findings further indicate evidence of developmental delays in 28% and anemia due to iron deficiency in 38% of the children assessed.

The survey was conducted by researchers at the University of São Paulo (USP) School of Nursing under the coordination of Professor Elizabeth Fujimori between February and April 2013.

The study, entitled “Effects of nutritional counseling under the IMCI strategy regarding food practices, nutritional status and child development,” received funding from FAPESP and the Maria Cecília Souto Vidigal Foundation (FMSCV) through a cooperative agreement between the two institutions.

Findings from the study were presented in March during the 1st Child Development Research Conference held at FAPESP.

“When parents fail to recognize the problem [of being overweight], they take a long time to seek help. Any change in nutrition during this phase of intense growth could affect the child, often in irreversible ways. The chance of growing up overweight and becoming an obese teen or adult facing cardiovascular disease increases greatly,” said Fujimori.

According to the researcher, the study was designed to evaluate the effects of nutritional counseling using the Integrated Management of Childhood Illness (IMCI) strategy on eating practices, growth, child development and the ability of mothers to recognize their children’s nutritional status.

“The IMCI strategy was proposed by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) during the 1990s and implemented in all Latin American countries, but only partially in Brazil. We have worked with this strategy in nursing training because it is very important for providing quality health care to children,” said Fujimori.

The study was organized into three phases. The first step involved assessing the health, nutrition and child development status, in addition to maternal practices related to feeding children under 3 who were receiving care at the Itupeva Basic Health Unit (BHU).

During the second phase, health professionals were invited to participate in nutritional counseling training through the adapted IMCI, which incorporated guidelines regarding the National Strategy for Healthy Complementary Nutrition (ENPACS). This government initiative seeks to train first-level health care providers to strengthen activities that promote complementary nutrition under Brazil’s Unified Health System.

A group of nurses underwent a 24-hour training session. Three other groups of aides, nursing technicians and community health workers attended a 16-hour training course. None of the invited physicians attended.

The training was performed between September 2013 and January 2014 through role playing and practical exercises on the topic.

The third phase, which is scheduled to occur between April and June 2014, will assess the effect that implementation of the training outcomes has had on sample mother-child pairs at the BHU.

According to Fujimori, the rate of anemia found in the initial survey was very similar to that found in a previous study conducted in 2001. “It was surprising to see that the rates continued to be high all these years later, despite public policies such as iron-fortified flours and preventative medicinal supplements,” she said.

Preliminary findings indicate that only 45% of children aged 6 to 18 months are receiving prophylactic iron supplementation, as prescribed by the Ministry of Health. Only 40% are regularly receiving the medicine Aditil, which combines vitamins A and D. Both supplements are provided free in the public network. Despite being prescribed these supplements, there are children who may not be taking them on a regular basis, the researcher explained.

The issues faced focused the training in order to contribute to the professionals to act in health care seeking lasting improvements in children’s health in the city, Fujimori said.

Unified language

Another study underway at the USP School of Nursing that seeks to improve care for children was presented during the 1st Child Development Research Conference.

Entitled “Qualification of nursing practices in the promotion of comprehensive childhood development,” the project is coordinated by Professor Maria de La Ó Ramallo Veríssimo, and it has received financial support from FAPESP and the FMCSV.

“The search for standardized language is fairly recent and is currently taking place in the field of nursing. A more inclusive and unified scientific language improves observation and refines nursing actions in caring for children aged 0 to 3,” Veríssimo said.

Based on a review of the scientific literature, the group proposed a new definition of the concept of “child development” and prepared a catalog to expand the professional overview of nursing in care provided through the basic health care network.

“The new concept goes beyond biological risk, often described in the literature as including the notion of environmental risk to child development, which may be related, among other things, to pregnancy, childbirth, maternal mental illness or a lack of resources or access to health services,” Veríssimo said.

The starting point for the review of the concept involved interviewing health care providers who worked in the municipal network of the cities of São Carlos, Itupeva, São José do Rio Pardo, Penápolis and Votuporanga. They had already participated in the training promoted by the FMCSV regarding expanded nursing, education, social work and general health care activities in caring for children. Subsequent steps involved teams working with two of the most well-known nursing classifications.

The North American Nursing Diagnosis Association – International (Nanda-I) classification was reviewed by 20 experienced nurses in the field of children’s health and validated by a group of specialists. The work was conducted as part of the doctoral project of Juliana Martins de Souza.

The revised terminology related to the diagnostics, findings and child development interventions of the International Classification for Nursing Practice (ICNP) – a program of the International Council of Nurses (ICN) thatwas coordinated by doctoral fellow Soraia Matilde Marques Buchhorn. The study included 84 questionnaires administered to nurses in two stages and with validation by groups of specialists at each stage.

The classification of nursing diagnoses related to child development was systematized and expanded to include environmental impacts on child development. Other important changes were a distinction between the concepts of growth and development and an emphasis on promoting development by stimulating the child in the family environment.

Among the project outcomes is a new application that offers nursing professionals possible diagnoses and a list of interventions that should be considered when developing a care plan according to the ICNP model. Also underway is the establishment of contacts with the associations responsible for the systematization and international publication of the revised classifications.